If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes with activities like, um, gardening. Think: finger and wrist joints so inflamed it feels like your hands have suffered a heat stroke from the inside out. Imagine: the joints of your toes so damaged you have to purchase shoes at a medical supply store, even though you will still be lucky to walk on a good day. Rheumatoid arthritis is a severe, inflammatory disorder that simultaneously deforms and disables.

Letterman – a pseudonym – and his doctor gave permission for Verilogue Inc., a marketing company, to audio-record their interaction. The clinic appointment was one of many that my colleagues and I analyzed to see what happens when doctors and patients discuss healthcare costs. That appointment revealed a disturbingly common problem – sometimes doctors and patients get so confused about insurance coverage, they can’t figure out how best to treat patients’ illnesses.